Health Committee on May 15th, 2008

[Dr. David Butler-Jones]

Just very quickly, within the federal role, and given the provincial responsibilities, in addition to coordinating activities so that we have a collective response nationally, we also have been adding to the national emergency stockpile in terms of mass anti-virals, etc. That's to go beyond what we've done jointly with the provinces and territories, to have that as a backup and support to that. As well as the facilitation of cross-jurisdiction licensing that we will have shortly, we have an agreement in principle around resource sharing between jurisdictions during public health emergencies, etc.

We're also developing a public health core--in other words, capacity that was there from a federal perspective to assist provinces as appropriate. So in the ways we can do that, within our jurisdiction we're continuing to try to build on that.

[Susan Kadis, Liberal, Thornhill, ON]

Thank you.

If I have a little more time, Mr. Chair, I'd like to know the expiration date of the Tamiflu stockpile that was purchased by the government in 2006 and what the contingency is after that expires.

[Dr. David Butler-Jones]

There are two things. One is that there are variable dates because they were purchased at different times. Normally the expiry is five years, but we're working with the manufacturer and researchers and others, because we think the actual shelf life will be much longer and that there are other strategies to deal with that. In addition, we're in ongoing conversations with the provinces and territories about how to renew that, when and if that is required into the future.

[Susan Kadis, Liberal, Thornhill, ON]

Finally, we heard testimony from the last witness that we're not anywhere near reaching our goal in terms of electronic health records. I think it's at 5%. We're trying to reach a goal of 50% by 2010, if I'm not mistaken. How are we going to reach that goal? I know our government had begun that process. You have added somewhat to it--modestly. But we're well below the goal.

It's such an important driver of improving Canadians' health and the health care system. Everyone is doing that globally. How can we expedite this? I believe more steps should be taken. I don't think we're going to reach that goal if we don't. What are your plans to do that?

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

Thank you for the question.

I think the 5% number actually deals with family physicians; that's not a system-wide number.

In any event, you're an Ontario MP, and of course so am I, and I think we can honestly say that Ontario has to keep moving forward. They have not reached some goals. But if you were to travel to Alberta, British Columbia, the province of Quebec, other places, you will see that there has been a lot of movement in these areas. For instance, the capital health region, in Edmonton, and north, in Alberta, is going to be 100% EHR by the end of this year. So there are a lot of improvements happening.

Our goal, of course, is to make sure it's not lumpy. We have to make that happen throughout the country. That's why Infoway Canada is part of the solution.

[Susan Kadis, Liberal, Thornhill, ON]

Thank you.

[The Vice-Chair, Liberal, Lui Temelkovski]

Thank you very much.

We move on to Mr. Brown, for five minutes.

[Patrick Brown, Conservative, Barrie, ON]

Thank you, Mr. Chairman.

Thank you, Minister Clement, for being here again today.

I have three questions, and I'll just let you delve into them.

First, I remember having a conversation with you once about the recruitment initiatives the federal government has for doctors and the funds that were allocated over a four-year period. I found that intriguing. Perhaps you could share that with the committee, because in small towns we frequently hear about physician shortages. The role the federal government is playing in recruitment is something that needs to be better known.

Second, I always ask at my hospital what their issues are so I can raise them at the health committee. They certainly mention lots of the areas of success they're seeing with the influx of funds for wait-time reductions. But one issue they raised with me is that they're always at capacity: 96% to 98% of the hospital beds are in use. That problem is common around the country. Do you have any thoughts on the capacity issues hospitals are facing?

Third, Mr. Minister, I understand you had a Dr. Kellie Leitch produce a report on healthy ways for children, and I understand that you have taken action on some of her recommendations. I think that would be interesting for the committee to hear. It's certainly a good-news story on how we're helping the health of young Canadians.

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

Let me just say a couple of things about recruitment.

One of the bits of good news that perhaps needs a little bit more media attention is the fact that we're always worried about the brain drain, when it comes to our physicians going to the United States, for instance. But for three years in a row in this country, more physicians have migrated from the United States to Canada than have migrated from Canada to the United States. So we're winning the brain-drain war; we're getting the brain gain. That's a very positive step.

More has to be done. As you know, we've increased our transfers to the provinces, but we also have a $38 million per year strategy, health human resource strategy, with the provinces. Part of it deals with international medical graduates. Part of it deals with focusing on where the recruitment and retention should be advanced. We are going to continue on that. I want to see some results out of that. I don't just want it to be money thrown away. So that's certainly one of the things I'm working on.

The capacity issue is a big issue in the hospital system. A number of provinces are starting to increase capacity by pushing some of the hospital-based functions into community care, for instance. That's what Ontario is doing. B.C. has a strategy on that. And I think Alberta will be going down this route a little bit more too. Certainly we're encouraging that. When we, as the federal government, on behalf of the federal taxpayer, put in 25% of federal funding, that's something we're always very interested in and we certainly do support.

Dr. Kellie Leitch's report focuses on a bunch of things, including injury prevention for kids, and some other child- and youth-specific policies--obesity issues, for instance. That was raised earlier in the committee. Obviously we're examining those very closely. And we believe we can implement a number of things.

This level of government has never had a comprehensive strategy for child and youth health and wellness. We're going to try to pull together a number of departments in government as well as things within my ministry to accomplish that goal.

[Patrick Brown, Conservative, Barrie, ON]

In conversation with physicians in my community, when they talk about the physician shortage they reference the early 1990s, when the then-NDP premier, who's now a Liberal MP, cut spots in medical schools, which was horrific for the physician population in Canada. And one thing that's great to know, with having you as health minister, is that I remember you opened a new medical school in northern Ontario, which I think was a great step forward.

One of the recognitions is that, as much as there's a shortage and we can recruit from elsewhere, until we have provinces opening up more medical schools, there's going to be a challenge. Do you know if other health ministers around the country are going to take bold steps, as you did as health minister, and create more medical enrolment spots?

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

Sure. Throughout Canada, more than 800 first-year undergraduate positions have been added in the last nine or ten years. That orthodoxy of the early nineties, and you mentioned Mr. Rae and other premiers at the time.... Bob Rae admitted in his memoirs that one of the worst things he ever did was cut medical school enrolment, which is saying a lot, because he did a lot of bad things. But regardless of that, we are reversing the trend now and we are seeing some improvements on that.

Northern Ontario School of Medicine is a big success story. I think other provinces are looking at opening new medical schools as well. And of course I'm very encouraging of that process.

You know it's a success when both sides at the table here are sparring over who should take the credit for the Northern Ontario School of Medicine. But you're right, I did announce that. I'm very proud of it. This year we'll have our first graduating year since the school was created.

If any of the graduates are listening, please stay in Canada and please consider Parry Sound—Muskoka.

[The Vice-Chair, Liberal, Lui Temelkovski]

Thank you very much.

Now we'll move on to Madame Wasylycia-Leis.

Welcome back. You will get your ten minutes.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Thank you very much. I apologize, but thank you for juggling the schedule so I could get my time in with the minister. Forgive me if I ask anything that anyone else has asked.

I want to focus on the state of our health care system, of which we've been hearing so much as we deal with the ten-year review of the health accord. I guess what I'm a little miffed at is that in fact in your address today you don't even mention the terms “national health care”, or “medicare”, or the Canada Health Act. There has been no attempt on your part, that I can see, in the estimates or your speech or your actions, that would say to me and to Canadians that you are concerned about the erosion of our health care system and the growing evidence of people having to pay for things they need, the rise of private health group clinics, the growth in P3s, and just the incredible erosion of our system without any sense that you're going to hold the provincial governments to task and try to craft a system that resembles medicare and builds on our principles.

Is there anything you can tell us that you believe in in terms of health care? I know in the House when I've asked you questions, you say you're a great believer in the single-payer system and in the five principles of medicare, but it seems to me that you're sitting back and letting privatization, commercialization, and erosion happen by osmosis, by stealth. I don't see leadership from you to actually fix the problem. In fact I see the opposite. We hear about, obviously, the money and the budget for P3s, which by all accounts are going to lead to further problems in terms of public health care. We hear about a federally sponsored trade mission going to the Caribbean to support private clinics that are marketing surgeries. We hear all the evidence from the provinces and no action from the federal government. I think Canadians deserve to know what your plan to save medicare is.

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

Thank you for the question.

Unfortunately you weren't here. Actually you were beaten to the punch by Mr. Fletcher--

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Oh, I'm surprised.

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

--our member from Winnipeg here.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

I didn't think anybody was going to ask this question, and certainly not anyone from your party.

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

He asked me a little bit about the Canada Health Act and how our party and our government are supportive of the CHA. Certainly we are interacting with the provinces and territories as they innovate their system to ensure that what they consider would be within the bounds of the CHA. I will continue to play that role. And I play that role quite forcefully, I think I should state for the record.

I think it would be fair to say, though, that we have been worried and concerned about the sustainability of the health care system. That's precisely why one of our five main promises in the last election was the wait-time guarantee and why we were so proud to at least launch the process, to have ten provinces and three territories have at least one wait-time guarantee to start with. Some provinces, like the province of Quebec, have announced three wait-times guarantees, and through our pilot projects we're announcing more wait-time guarantees.

These wait-time guarantees are all about reducing wait times and increasing the accessibility of the system, all within the public system—let me state that for the record: all within the public system—using innovative managerial techniques and administrative techniques to make progress as well. I think we are in fact on the same page on that.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

I appreciate that. Although we've had good testimony from the Wait Time Alliance folks, most will say that the improvement in the wait-time issue is so slight as to hardly be noticed in many cases. It has not made a big impact on people's need to access the system on a timely basis.

Here are the crises we're facing overall in Canada, and I don't hear you mention any of them in your speech. A health human resource crisis--whether we're talking about doctors, nurses, technologists, or any other health care workers or professionals, on every front there is a serious shortage and crisis. We have a national pharmaceuticals strategy for which there has been no action on your part or the part of your counterparts that I can see, and it's sitting on the shelf gathering dust. There is no national emergency room strategy. There's no national birthing strategy. There's no national.... I could go on and on.

We've had so many representations from groups saying that in terms of a pan-Canadian strategy that will deal with the serious shortcomings of the system and help us sustain medicare and build on it, there's nothing. We don't even have an extension of the human resources strategy, which has ended as of now. There's no new program. Instead we have in the budget little cuts here and there, and no sustaining program. There are cuts to first nations and Inuit health. There are cuts to the Assisted Human Reproduction Agency. There are cuts to the Patented Medicine Prices Review Board. There are cuts to graduate students and post-graduate students in public health. There are cuts to HIV and AIDS. There are cuts to the Public Health Agency.

In every instance where you'd expect to see some focus, some vigour, some energy, you're retreating. So where is the pan-Canadian strategy that is desperately needed on so many fronts?

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

It would come as no surprise to suggest that you and I might disagree on interpreting these things.

We're the first government in the history of the country to announce a national cancer strategy. I notice you didn't mention that. We are well on our way to a national cardiovascular strategy. Those two diseases together account for the great majority of deaths within the health care system, within society.

We've retooled the national diabetes strategy and we've been working on a number of other disease-specific strategies, and we will continue to do so. We have a strategy when it comes to obesity. We have a strategy when it comes to kids' health. These things are ongoing, and we will continue on that front.

You were not here for the health human resources discussion we had, but I did mention that there is within the health accord a $38 million per annum fund that we use with the provinces to assist them in some of their strategies, whether it's international graduates or, as we just finished talking about, medical schools and new places for human health resources within the education system. I did mention as well that for three years in a row we've actually taken more doctors from the United States than the United States has taken from us, so we've had a brain gain in those areas.

I'm not saying we're beyond the point of crisis. I'm saying that we are making steady progress, and the federal government is part of the solution.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Don't you think we actually need a national health human resource strategy that has clear targets, has an understanding of where the shortfalls are, and has some serious tenets to it that will give hope to people?

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

I would put it to you that when you look at who has the levers to make the most difference, whether it's the regulatory colleges, credentialing issues, those kinds of issues, access to medical resident spaces, those are all with the provinces. We are funding the provinces more and more every year, but I don't think it is helpful....

Dr. Bennett made an interesting point about getting along with provinces, which we are doing when it comes to health care, and I respect them for the role and responsibility they have, just as they respect me for the role and responsibility I have.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

I think the provinces would love to see some concerted leadership on your part, the kind of leadership we saw many years ago when the federal government actually got involved in setting up schools of medicine. I think we're in that kind of situation where it begs for a serious initiative on the part of the federal government.

We're not dealing with only a provincial, local, territorial issue. We're dealing with something that has to be dealt with on a national basis, or we lead to raiding and serious problems jurisdiction to jurisdiction.

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

We're certainly not denying there's an issue. I guess what I'm saying is that we are working with the provinces and territories.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Given the ageing population, there's a serious lack of any kind of national strategy that is desperately needed and no attempt on your part to work toward national home care or community care programming. Instead, what we seem to see are cuts. You or the Liberals, both of you, eliminated the secretariat on palliative and end-of-life care, a vital pillar of the program needed in terms of an ageing population. Where is the program for home care, continuing care, and palliative care in your branch? Where is the national strategy?